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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In severe hemorrhagic shock, left ventricular (LV) diastolic dysfunction is an early sign of cardiac failure due to compromised myocardial oxygenation. Immediate fluid replacement or, in particular, administration of a hemoglobin-based oxygen carrier (diaspirin cross-linked hemoglobin; DCLHb) improves myocardial oxygenation; therefore, positive effects on LV diastolic function could be expected. The effects of fluid resuscitation from severe hemorrhagic shock with DCLHb were investigated in 20 anesthetized domestic pigs. After generation of a critical left anterior descending coronary artery stenosis (narrowing of the artery until disappearance of reactive hyperemia after a 10-second complete vessel occlusion), hemorrhagic shock (mean arterial blood pressure 45 mm Hg) was induced within 15 min by controlled blood withdrawal and maintained for 60 min. Fluid resuscitation consisted of replacement of the plasma volume withdrawn during hemorrhage by infusion of either 10% DCLHb (DCLHb group, n = 10) or 8% human serum albumin (HSA) oncotically matched to DCLHb (HSA group, n = 10). After completion of resuscitation, an observation period of 60 min elapsed. Measurements of central hemodynamics, myocardial oxygenation, and LV diastolic function were performed at baseline, after induction of critical coronary artery stenosis, after 60 min of hemorrhagic shock, immediately after resuscitation, and 60 min later. While 5 out of 10 animals treated with HSA died within the first 20 min after fluid resuscitation from acute LV pump failure, all DCLHb-treated animals survived until the end of the protocol (p < 0.05). Despite superior myocardial oxygenation due to augmentation of the arterial O(2) content as well as of coronary perfusion pressure, no beneficial effects on LV diastolic function were observed after infusion of DCLHb. Peak velocity of LV pressure decrease (dp/dt(min)) did not reveal significant differences between the two groups. Immediately after completion of fluid resuscitation with DCLHb, the time constant of LV diastolic relaxation (tau) was prolonged when compared with HSA-treated animals (p < 0.05), indicating retardation of early LV diastolic relaxation. Our data suggest that DCLHb fails to improve LV diastolic function after fluid resuscitation from severe hemorrhagic shock. However, positive effects on myocardial perfusion and oxygenation result in a significant reduction of the mortality of severe hemorrhagic shock.
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PMID:Diaspirin cross-linked hemoglobin fails to improve left ventricular diastolic function after fluid resuscitation from hemorrhagic shock. 1180 91

In this prospective study 37 children (ranging 2 months-15 years) with acute pneumonia were evaluated by Doppler echocardiography for the presence of pulmonary hypertension (PH). The goal of this study was to determine the frequency of PH in children with acute pneumonia because the diagnosis of PH influenced the treatment of pneumonia in these patients. The patients who had more than 35 mmHg of systolic pulmonary arterial pressure were considered to have PH. In our study PH was found in 15 (40.5%) of 37 patients. We did not find any significant difference for the parameters including the age, weight, height, clinical symptoms and signs (fever, cough, dyspnea, tachycardia and tachypnea etc.), and laboratory findings such as hemoglobin, PCO2, HCO3 and PO2 between the patients with and without PH (p>0.05). However, there was a significant difference in cyanosis, cardiac failure, blood pH level and O2 saturation measured by pulse oximetry between the patients with and without PH (p<0.05).
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PMID:Doppler echocardiographic evaluation of pulmonary artery pressure in children with acute pneumonia. 1189 Feb 20

Single intrauterine death may occur in twin-twin transfusion syndrome. We investigated why the outcome of the surviving twin is fairly good when the donor twin dies first compared with when the recipient twin dies first. A detailed hemodynamic study was performed using Doppler ultrasound in a twin pregnancy affected by twin-twin transfusion syndrome before and after a single intrauterine death that occurred in the donor twin at 26 weeks' gestation. The recipient twin was expected to die due to severe right cardiac failure with functional stenosis of the pulmonary artery 2 days before the cotwin's death. The donor twin's death caused a prompt resolution of cardiac failure and improvement in other indices, including flow velocity waveform patterns of the umbilical vein, the middle cerebral artery and the ductus venosus. A healthy, premature female neonate weighing 1630 g with a hemoglobin concentration of 17.8 g/dL was delivered by Cesarean section following rupture of the fetal membranes 28 days after the episode. Hemorrhaging from the surviving twin to the dead twin that occurred just before or after the cotwin's death may have contributed to the decrease in volume overload in the recipient twin, leading to a prompt amelioration of the critical hemodynamic indices. The early death of the donor twin may thus have played a significant role in improving the status of the recipient twin in this case of twin-twin transfusion syndrome.
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PMID:Intrauterine death of one twin, with rescue of the other, in twin-twin transfusion syndrome. 1189 55

Despite improvements in dialysis therapy, the mortality rate of patients with end stage renal disease (ESRD) has remained high. A relatively high proportion of uremic patients dies within one year after the initiation of dialysis treatment. The aim of this study was to evaluate predictors for this early mortality in patients with ESRD. A total of 66 uremic patients were included in the study. Patients were divided in those who survived < 1 year (n = 17) and those who survived > or = 1 year (n = 49). We compared the prevalence of diabetes and hypertension and of vascular diseases as well as the prevalence of heart insufficiency (EF < 30%) and left ventricular hypertrophy (LVH). Additionally, we estimated the laboratory parameters serum creatinine, creatinine clearance, BUN, cholesterol, triglycerides, fibrinogen, serum protein, serum albumin and hemoglobin, and evaluated the indications for the initiation of dialysis therapy in both patient groups. The patients with survival < 1 year were significantly older (64+/-12 vs. 54+/-14 years, p<0.01) and showed a lower BMI (22+/-3 vs. 25+/-3, p<0.01) than those who survived > 1 year. The prevalence of diabetes (70% vs. 31%, p<0.05), cardiac insufficiency (70% vs. 16%, p<0.025), cardiovascular disease (65% vs. 28%, p<0.05) and peripheral vascular diseases (70% vs. 28%, p<0.05) was significantly higher in the patients with early mortality. The prevalence of hypertension was similar in both groups, however, the prevalence of LVH was significantly higher in the patients who survived < 1 year (88% vs. 37%, p<0.05). Laboratory parameters were not significantly different in the two groups of patients, with the exception of serum albumin, which was significantly lower in the patients with early mortality (3.5+/-0.6 vs. 3.9+/-0.4 g/l, p<0.02). Hyperhydration was the most common indication for the start of dialysis in patients with early mortality (59% vs. 13%, p<0.025). Cardiac insufficiency was the most common cause of death in these subjects (n = 10, 59%). Six individuals (12%) died within four weeks after initiating dialysis therapy. Thus, there are several predictors for early mortality in end-stage renal disease patients, including high age, low BMI, the presence of diabetes, coronary heart disease, heart insufficiency and LVH, as well as low serum albumin levels. A relatively high percentage of patients die shortly after the start of dialysis therapy. Heart insufficiency is the most common cause of early death in these patients.
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PMID:Predialysis management and predictors for early mortality in uremic patients who die within one year after initiation of dialysis therapy. 1207 93

Patients with chronic heart failure (HF) have a reduced skeletal muscle blood flow which can in part explain reduced exercise tolerance and increased ventilation. All the techniques commonly employed to measure skeletal muscle blood flow have limitations that reduce their accuracy and clinical application. Near infrared spectroscopy (NIRS) is a noninvasive, inexpensive, and reproducible technique able to monitor muscle oxygenation both at rest and during exercise, providing information about tissue perfusion. The principle of NIRS is based on the observation that the light absorption characteristics of hemoglobin (Hb) and myoglobin (Mb) in the near infrared region (700-1000 nm) change depending on their relative saturations. In humans, NIRS has been employed to monitor skeletal muscle oxygenation during exercise and/or after cuff-induced limb ischemia in normal subjects as well as patients with chronic HF. Patients with chronic HF have a reduced Hb/Mb oxygenation at any matched work rate and a more rapid deoxygenation above the anaerobic threshold than normal subjects. More recently, NIRS has been used to determine the kinetics of muscle oxygenation in recovery after constant work rate exercise, providing evidence of an inverse relation with cardiac function as assessed by peak oxygen uptake. In conclusion, NIRS appears to be a new promising noninvasive technique for studying muscle oxygenation in a variety of experimental models. (c)1999 by CHF, Inc.
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PMID:Monitoring skeletal muscle oxygenation during exercise by near infrared spectroscopy in chronic heart failure. 1218 15

Cardiovascular disease is virtually a sine qua non of chronic kidney disease, as is poor quality of life. Dialysis patient for example, have cardiovascular death rates 10 - 20 times those of the general population. Recent estimates indicate that at least half of all patients starting dialysis therapy will have an admission for a major cardiovascular event within 5 years, of which cardiac failure is the most common. Both experimental and clinical studies suggest that the cardiovascular system in uremia is in a state of premature senescence, one which is poorly suited to the supraphysiological hemodynamic demands to which it is subjected. Most patients develop cardiomyopathy, which clearly predisposes to cardiac decompensation. Anemia and hypertension are the most obvious modifiable overload parameters in uremic patients. Several prospective observational studies have demonstrated anemia to be an independent risk factor for each step in the process leading from hemodynamic overload, through maladpative left ventricular enlargement to left ventricular failure and death. This process starts with declining renal function, long before end-stage renal disease, the traditional time at which intervention has started to be seriously considered. The case for normal hemoglobin in patients with chronic kidney disease is still greatly disputed. Observational studies, which examine left ventricular size, quality of life, functional status, hospitalization and survival, are overwhelmingly supportive. Intervention trials, to date, suggest clear benefits of a physiological approach to anemia management in terms of quality of life, and likely benefits in terms of left ventricular stress minimisation and associated remodelling. Whether these translate into a reduction in outcomes like cardiac failure or death remains an unanswered question.
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PMID:Should hemoglobin be normalized in uremic patients? 1222 28

A report issued by the World Health Organization's Maternal Health and Safe Motherhood Program reveals alarming rates of anemia among pregnant women in developing countries. Three-quarters of pregnant women in southern Asia and over half of those in Africa have hemoglobin levels under 110 gm/liter, compared with 17% of their counterparts in Europe and North America. 39% of pregnant women in Latin America and 71% of those in Oceania (excluding Australia and New Zealand) are anemic. The 3-7% of pregnant women in the Third World who suffer from several anemia (under 70 gm/liter) are at risk of mortality from heart failure. Even women with moderate levels of anemia are in danger of severe health consequences as a result of the small amount of blood lost during a normal pregnancy. A cycle of deteriorating health from pregnancy to pregnancy occurs when these women are unable to replace the blood lost during childbirth and their anemia becomes exacerbated by the demands of breastfeeding.
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PMID:Anaemia during pregnancy - a major public health problem. 1228 32

Prenatal administration of iron and folate can prevent nutritional anemia and boost the hemoglobin of those who are already anemic, strengthening women for delivery and building their resistance against infection. Regular screening is needed, since women with more than mild anemia need additional treatment. Ideally a woman should have a hemoglobin level of at least 110 g/l by the time of delivery. Many lack the iron stores they need for pregnancy, delivery, and lactation. Yet prenatal administration of oral iron supplements could give them higher hemoglobin levels and adequate stores. Folate deficiency is less important as a cause of anemia than lack of iron, but folate needs are increased by malaria, thalassemia, and sickle cell disease. Malaria causes severe complications in pregnancy, and studies from sub-Saharan Africa report malaria parasite rates 30-40% higher in primigravidae than in nonpregnant women. Persistent infection increases the level of anemia. Where intestinal parasites are common, anthelmintic drugs should be routinely given to all pregnant women. The transmission of HIV by blood transfusion makes it more urgent to prevent anemia and avoid the need for blood transfusions. According to a WHO document in southern Asia, 75% of pregnant women are anemic compared with 17% in Europe and North America. In Africa, 50% of pregnant women are anemic, as are 39% in Latin America and 71% Oceania (excluding Australia and New Zealand). Moderate anemia (70-109 g/l) is estimated to be present in 25-33% of pregnant women, with the highest prevalence in Southern Asia, Oceania, and Sub-Saharan Africa. Surveys show that from 3-7% of women suffer from severe anemia 70 g/l), which carries a high risk of death from heart failure. In pregnant women, even the relatively small blood loss associated with a normal delivery can result in death.
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PMID:Anaemia -- the weak get weaker. 1228 38

Fever is often an indication of a serious illness in children. In areas endemic to malaria, hospital workers should check a febrile child for malaria parasites. Children with a fever associated with meningitis or malaria need immediate attention. To diagnose meningitis: microscopic examination of cerebrospinal fluid obtained by lumbar puncture is the only reliable method. If a febrile child also has a stiff neck, health workers should immediately administer antibiotic treatment without waiting for the results of the lumbar puncture. If available and in epidemic situations, oily chloramphenicol may be administered, since it is effective in a single dose. Treatment with other antibiotics should last for 10 days in children and 14-21 days for young infants. To diagnose malaria in endemic areas: laboratory technicians should examine thick and thin blood films of sick children with fever. Health workers must consider as medical emergencies children who have a slide positive for malaria parasites plus severe anemia, hypoglycemia, deep rapid breathing, any indication of kidney malfunction or failure, or altered consciousness. They should begin antimalarial treatment with quinine, the drug of choice for severe and complicated malaria. In cases of convulsions lasting longer than 5 minutes, health workers should administer anticonvulsants and take actions to prevent aspiration pneumonia. If the fever persists for 14 days or if the child does not emerge from unconsciousness and someone in the family has active tuberculosis, health workers should consider tuberculous meningitis. If a child with malaria has low hemoglobin levels (5 g/dl) and many malaria parasites in the blood and is in heart failure, a blood transfusion (15-20 ml/kg whole blood over 4 hours) and infusion of 1 mg/kg fursemide (to prevent cardiac failure) are needed. If the preceding case has pulmonary edema, a single dose of fursemide at the same dosage is needed to prevent overloading of the circulation. Health workers should closely monitor that intravenous fluids not exacerbate brain swelling.
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PMID:Managing meningitis and severe malaria. 1229 72

We studied the role of oxidative stress in the pathogenesis of primary pulmonary hypertension. In patients with primary pulmonary hypertension the content of malonic dialdehyde in the plasma was higher than in healthy volunteers (5.18 0.46 and 2.95 0.14 nmol/liter, respectively, p<0.01). However, glutathione peroxidase activity in the plasma decreased in these patients (0.50 0.17 vs. 1.19 0.14 U/ml in the control, p<0.05). By contrast, glutathione peroxidase activity in erythrocytes from patients surpassed the control (6.13 0.39 and 4.63 0.45 U/h hemoglobin). The increase in malonic dialdehyde content in the plasma and glutathione peroxidase activity in erythrocytes and the decrease in glutathione peroxidase activity in the plasma were most pronounced in patients with severe cardiac insufficiency and pulmonary hypertension. Our results indicate that antioxidant preparations improve the prognosis in patients with primary pulmonary hypertension.
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PMID:Oxidative stress in patients with primary pulmonary hypertension. 1244 71


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